Article for positioning mesh over tissue

ABSTRACT

An article of manufacture suitable for positioning a sheet of mesh material over tissue is described. In one embodiment, the article comprises a surgical tack having a hook-type material such as Velcro® material carried by the tack, e.g., secured to the top of the head thereof. A plurality of such tacks are positioned around the site of a hernia or the like and the mesh is positioned over the site and the tacks. The mesh is made of a loop-type Velcro® material or the like which allows the mesh to be releasably engaged and disengaged from the hook-type material carried by the tacks so that the mesh can be appropriately positioned over the tissue.

FIELD OF THE INVENTION

[0001] This invention relates to surgical devices and, moreparticularly, to surgical articles used to position and fix mesh overtissue for repair of abdominal wall defects.

BACKGROUND OF THE INVENTION

[0002] Abdominal wall defects or hernias are commonly repaired using aphysiologically compatible synthetic mesh such as apolytetrafluoroethylene mesh, polypropylene mesh, and the like.Tension-free mesh repair of hernias is preferred over conventionalsuture closure, which often results in the creation of significanttension and subsequent recurrence of the hernia. More recently,video-assisted (laparoscopic) technology has been utilized to repair theabdominal wall defects from a posterior (from inside the abdomen)position, thus offering the potential for a lower incidence ofsubsequent recurrence of the hernia. Where the laparoscopic technique isutilized, the synthetic mesh is typically secured against the abdominalwall using surgical tacks of various types, for example of the typedisclosed in U.S. Pat. Nos. 5,728,116 and 6,036,701, and also of theQ-ring type commercially available from Onux Medical, Inc. of Hampton,NH.

[0003] One of the challenges encountered during laparoscopic herniarepair is the placement of the mesh and the tacks in the preciselyintended location to provide adequate overlap of the mesh with thesurrounding abdominal wall tissue. With each application of anadditional surgical tack, repositioning of the mesh (when necessary)becomes more and more difficult, if not impossible. In addition, duringthe early process of tacking the mesh to the abdominal wall, the fieldof view is often significantly hindered by the partially dangling pieceof mesh. This limitation may reach unsafe levels in cases of largeabdominal wall defects requiring large pieces of mesh, with significantpotential for inadvertent injury to abdominal organs.

[0004] There is, therefore, a need for improving the existing techniqueof laparoscopic hernia repair through the use of a tack or the like thatwould allow placement of the tacks before obliteration of the view bythe mesh, and subsequent near-perfect positioning and repositioning ofthe mesh as needed.

SUMMARY OF THE INVENTION

[0005] The present invention provides a safe and efficient means orarticle for the application and subsequent repositioning of syntheticmesh to the abdominal wall with minimal risk of injury to abdominaltissue and organs.

[0006] Accordingly, the invention is an article suitable for positioninga sheet of surgical mesh over tissue and comprising a mesh engagingmaterial associated with a tack adapted to be fastened to the tissue.The mesh is releasably engaged and disengaged from the mesh engagingmaterial associated with the tack so as to allow the positioning andsubsequent repositioning and stretching of the mesh over the tissue.

[0007] In one embodiment, the tack includes a head bearing a hook-typefiber material and a tissue anchoring member which depends from thehead. The tack is secured to the tissue and the mesh material isreleasably engageable with the hook-type material carried by the tack.In this manner the mesh material can be positioned and repositioned overtissue as desired by the surgeon.

[0008] In another embodiment, the tack secures a piece of the meshengaging material to the tissue. The mesh can then be pressed againstthe mesh engaging material secured to the tissue and is releasably heldin place by the mesh engaging material.

[0009] Other advantages and features of the present invention will bemore readily apparent from the following detailed description of thepreferred embodiments of the invention, the accompanying drawings, andthe appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

[0010] In the accompanying drawings forming part of the specificationand in which like numerals are employed to designate like partsthroughout the same,

[0011]FIG. 1 is an enlarged, partial front elevational view of asurgical tack provided with releasable mesh engagement element;

[0012]FIG. 2 is a top plan view of a patch of surgical mesh suitable forreleasable engagement to the mesh engagement element shown in FIG. 1;

[0013]FIG. 3 is a front elevational view of the entire surgical tack ofFIG. 1;

[0014]FIG. 4 is a perspective view of the surgical tack of FIG. 3provided with a slotted head;

[0015]FIG. 5 is a perspective view of a tack similar to that of FIG. 3and provided with a head configured to receive a Torx driver;

[0016]FIG. 6 is a perspective view of a tack similar to that of FIG. 3and configured to receive a Phillips driver;

[0017]FIG. 7 is a perspective view of a tack similar to that of FIG. 3and configured to receive an Allen driver; and

[0018]FIG. 8 is an enlarged, fragmentary front elevational viewdepicting the releasable mesh engagement element held in place with aQ-ring type of tack.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0019] The invention disclosed herein is susceptible of embodiment inmany different forms. Shown in the drawings and described hereinbelow indetail are preferred embodiments of the invention. It is to beunderstood, however, that the present disclosure is an exemplificationof the principles of the invention and does not limit the invention tothe illustrated embodiments.

[0020] Moreover, it is understood that the specification herein does notnecessarily describe the details of the surgical tack or the releasablemesh engagement element that are known in the art and that will berecognized as such by those skilled in the art. The detaileddescriptions of these elements are not necessary to an understanding ofthe article of the present invention. Accordingly, such elements areherein represented and described only to the degree necessary to aid inan understanding of the features of the present invention.

[0021]FIGS. 1, 3 and 4 depict a preferred embodiment of the presentinvention in which article 10 comprises a surgical tack 11 having areleasable mesh engagement element or member 20 attached to the top ofhead 12.

[0022] Head 12 has a circular, disk like figuration and includes a body14 and top and bottom radial faces 16 and 18, respectively. The top face16 of the head 12 is covered with a circular, disk shaped releasablemesh engagement member, such as patch 20, which is preferably made ofand includes hook-type Velcro® or the like latching fiber material 21.The mesh engagement member such as patch 20 may be secured to the topface 16 of the head 12 by any known means including, but not limited to,adhesive applied either directly to the top of the head 12, to the lowersurface of the mesh engagement member 20, or both. A tack driver cavity,such as slot or straight slit 22, extends across top face 16 and intothe body 14 of head 12. The slot 22 is configured to receive acomplementary driver.

[0023] The tack 11 additionally comprises an elongate spiral screwmember or base 24 which extends generally away from the bottom radialface 18 of the head 12. The spiral screw member 24 terminates in adistal tissue piercing tip 26.

[0024]FIGS. 5-7 depict alternate respective article embodiments 100, 200and 300 similar in structure to the article 10 except that therespective heads 112, 212 and 312 of the tacks 111, 211 and 311respectively incorporate cavities 122, 222 and 322 structured and shapedto accept Torx, Phillips or Allen drivers for driving and securing thetacks into tissue for the purposes described in more detail below.

[0025] The article 10 of the present invention is suitable for use in avariety of surgical procedures including, but not limited to, the repairof ventral hernias. In connection with the repair of ventral hernias, anincision is first made into a patient's abdominal cavity in order toaccess the site of the hernia (i.e., abdominal wall defect) usingconventional surgical techniques. After the site has been prepared usingconventional surgical techniques, several tacks capable of releasablyholding a surgical mesh are secured around the perimeter of theabdominal wall defect using conventional tacking devices such as, forexample, a surgical grasper, a tack driver, or alternatively, a tackinggun which has been pre-loaded with a predetermined number of thesurgical tacks.

[0026] The tacks 11 are advantageously secured to the tissue around theabdominal wall defect sought to be repaired prior to the insertion ofany mesh material into the abdominal cavity, and with the full view ofthe abdominal wall defect and surrounding internal organs. Thereafter,an appropriately sized sheet or patch of the biocompatible surgicalmesh, for example, such as the sheet of mesh material 28 depicted inFIG. 2, is inserted through the incision and positioned over the site ofthe hernia with the peripheral edges thereof overlying the tacks. Themesh material is then pressed into abutting contact against the tacks 11and, more specifically, against the heads 12 thereof so as to cause theloop-type material comprising the fabric of the mesh 28 to becomereleasably intertwined, latched and engaged with the hook-type material21 of tack 11 as shown in FIG. 1. The mesh 28 may then be selectivelydisengaged or released from tack 11, and then subsequently selectivelystretched and re-attached or re-engaged with the latching fiber materialuntil the optimal positioning and stretching of the mesh 28 over thetissue site has been achieved.

[0027] Once the desired mesh placement has been accomplished, any one ofa number of conventional tacking devices may be used to applyconventional surgical tacks to further secure and maintain the mesh 28over the site of the hernia. The hernia repair procedure is thencompleted in a conventional manner and the incision in the wall of theabdominal cavity is closed using conventional surgical sutures.

[0028] The foregoing description is to be taken as illustrative, but notlimiting of the scope of the present invention. Still other variantswithin the spirit and scope of the present invention will readilypresent themselves to those skilled in the art such as, for example, thealternate article 500 shown in FIG. 8 where a patch or strip 520including Velcro® type hook material 521 is positioned against thetissue 522 and a Q-ring type tack 511 of the type manufactured by OnuxMedical, Inc. of Hampton, NH is driven through the patch 520 and intothe tissue 522 to fasten the patch 520 to the tissue. It is understood,of course, that a plurality of patches such as patch 520 are positionedaround the hernia site, and that a plurality of the tacks 511 are driventhrough the patches 520 respectively. The mesh 528 is then releasablysecurable to the aforesaid plurality of patches in the same manner asthat described above with respect to the tacks 11.

I claim:
 1. An article of manufacture suitable for positioning a sheetof mesh over tissue comprising a tack adapted to be fastened to thetissue and mesh engaging material carried by the tack for releasableengagement of the mesh.
 2. The article of manufacture in accordance withclaim 1 wherein the tack has a base for fastening the tack to the tissueand a head which supports the mesh engaging material.
 3. The article ofmanufacture in accordance with claim 2 wherein the mesh engagingmaterial is a hook-type fiber material adhesively attached on the top ofthe head of the tack and the mesh is a loop-type fiber material adaptedfor releasable engagement with the hook-type fiber material.
 4. Thearticle of manufacture in accordance with claim 1 wherein the meshengaging material is carried by a Q-ring type tack.
 5. The article ofmanufacture in accordance with claim 4 wherein the engaging material isa hook-type fiber material and the mesh is a loop-type fiber materialadapted for releasable engagement with the hook-type material.
 6. Asurgical tack for use in positioning and repositioning a sheet of meshmaterial over tissue, the tack comprising: a head having hook-type fibermaterial disposed thereon; and a tissue piercing and engaging memberextending away from a bottom face of the head, whereby the tack isadapted to be secured to the tissue and the mesh material is releasablyengageable with the hook-type material.
 7. The surgical tack of claim 6wherein the tissue piercing and engaging member comprises a spiral coilmember terminating in a piercing tip.
 8. The surgical tack of claim 6wherein the head defines a cavity adapted to accept a driver forfastening the tack into the tissue.
 9. The surgical tack of claim 6wherein the strip of hook-type fiber material is adhesively secured tothe head.
 10. A method of positioning and securing a sheet of meshmaterial over tissue comprising the steps of: (a) securing a pluralityof tacks to the tissue, each of the tacks having a mesh engagementelement associated therewith; (b) positioning the sheet of mesh materialover the tissue and the tacks; (c) pressing the sheet of mesh materialagainst the tacks and the mesh engagement elements thereon; and (d)adjusting the position of sheet of mesh material over the tissue byreleasably engaging and disengaging the sheet of mesh material from themesh engagement elements.
 11. The method of claim 10 wherein step (a)includes positioning a plurality of the mesh engagement elements to thetissue and then driving a plurality of the tacks through the meshengagement elements and into the tissue.
 12. The method of claim 10further comprising the step (e) of fastening the sheet of mesh materialto the tissue following step (d).